Healthcare Provider Details

I. General information

NPI: 1801509831
Provider Name (Legal Business Name): BRITTANY LIEBERMANN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/04/2023
Last Update Date: 01/04/2023
Certification Date: 01/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

221 UPPER RIVERDALE RD APT 13F
JONESBORO GA
30236-1020
US

IV. Provider business mailing address

221 UPPER RIVERDALE RD APT 13F
JONESBORO GA
30236-1020
US

V. Phone/Fax

Practice location:
  • Phone: 470-699-7171
  • Fax:
Mailing address:
  • Phone: 470-699-7171
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberMT013662
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: